L.A. Care Covered: 2018 Premium Rate FAQs

L.A. Care Covered: 2019 Premium Rate FAQs

Your questions answered about this year's rate premiums

2019 Premium Rate FAQs

The 2019 Sign-Up Period for Covered California™ ended on January 15, but certain life events make you eligible to apply for health coverage if you need it. Visit Sign-Up and Enrollment Periods to learn more about Special Enrollment. 

No one plans to get sick or injured. But life is full of unexpected events, including ones that affect your health. Medical treatment can be very costly – a simple broken leg can cost thousands of dollars.

Having health insurance gives you peace of mind about the unexpected. L.A. Care can help you, as we offer affordable choices and comprehensive care with one of the largest provider networks among Covered California plans.

For 2019, L.A. Care has some of most affordable premiums in Los Angeles County for the Silver, Gold and Platinum tiers. Most residents like you are eligible for the consumer subsidies that are still available under the Affordable Care Act (ACA), and this helps keep your premium costs affordable. 

While health care is complicated, L.A. Care has experts to walk you through the process. If you need help applying for coverage or figuring out if you qualify for financial assistance, call us at 1-855-222-4239 (TTY/TDD 711). To help you further, we have answers below to frequently asked questions about 2019 rates.

When can I enroll?

The 2019 Sign-Up Period for Covered California ended January 15 and the next period will open in the fall. Certain life events, however, make you eligible to apply for health coverage if you need it. Visit Sign-Up and Enrollment Periods to learn more about Special Enrollment. 

Why should I choose L.A. Care Covered?

L.A. Care’s premiums are among the most affordable in all of Los Angeles County for the Silver, Gold and Platinum tiers.

  • You get peace of mind ― when accidents happen or you or a family member gets sick, you have the security of knowing that you are protected from the cost of unexpected medical expenses.
  • You can count on a health plan that was created to serve you ― Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide quality health coverage to Los Angeles County residents. As a not-for-profit health plan, L.A. Care is dedicated to meeting the health care needs of all Angelenos. This includes keeping monthly premium rates affordable. 
  • You will have access to the largest provider network among Covered California Plans ― L.A. Care continues to expand the number of doctors, hospitals and medical groups in our provider network within the communities where you live, work and play. Our network includes 63 hospitals, 2,900 physicians and 1,780 pharmacies, including CVS and Rite Aid stores.
  • You will get no-cost preventive and wellness care ― This means that you may have no co-pays or co-insurance, and you do not have to meet your deductible (if there is one for your plan), before full coverage for preventive care services begin.
  • You can take advantage of all the programs and services we offer ― Other features include a free Nurse Advice Line that is available to all members, 24 hours a day, 7 days a week. Our five local Family Resource Centers offer health education, exercise and cooking classes, as well as disease management programs ― all available at no cost.
How will I know which premium I will be paying?

The rate you pay depends on your annual income, household size and primary age of the subscriber. To find out estimated rates, call 1-855-222-4239 (TTY/TDD 711) for free and confidential assistance. You can also visit the L.A. Care Covered website to use the rate calculator to learn about coverage options.

I heard people can't get help anymore to pay for premiums. Is that true?

There is still financial assistance available because the Affordable Care Act's consumer subsidy has not gone away. You can still get affordable coverage. 

L.A. Care encourages our current members and those looking for health insurance to ask questions and get quotes so you can see the rates for yourself. Despite what is happening in Washington, D.C., you can still find affordable coverage that will work for you.

If you need help figuring out if you qualify for financial assistance, please call us at 1-855-222-4239 (TTY/TDD 711).

Isn't the President ending the Affordable Care Act? Why should I bother?

Please don't be discouraged from shopping for health insurance. Health coverage is extremely important, both to promote your wellness and well-being, and in case of emergencies or a serious illness, where costs can be devastating. 

The Affordable Care Act is still here, still in effect and still providing the benefits of health care to those who could never afford it before. Despite the uncertainties we are facing due to changes coming out of Washington D.C., we are committed to continue participating in Covered California and to serving our L.A. Care members.

L.A. Care encourages you to take advantage of affordable rates and the consumer subsidy that is still available for those who need financial assistance. It's worth taking the time to shop for a quality health plan to see the costs and benefits for yourself. 

Why should I have coverage if there’s no penalty?

Life happens and the unexpected can lead to financial distress. Being covered gives you the peace of mind that you and your family are protected from costly medical expenses.

How will I know these premiums will not change once I am enrolled?

Barring any changes to your situation, premiums for the plan that you purchase for 2019 will remain the same throughout the entire year.

Should I move to the lower cost plan during Open Enrollment?

The annual Sign-Up Period is a great time to review your plan benefits and make changes for the upcoming year. If you’re happy with your metal tier plan and expenses, then you don’t need to make any changes.

Here are some things to consider if you are deciding to move to a lower cost plan:

  • How many times did you see a doctor this past year?
  • Did you fill any prescriptions on a regular basis?
  • Do you anticipate your use of health services to increase, decrease, or remain the same in 2018?
  • Did you pay more in out-of-pocket expenses than you expected?

If you are deciding to move from a Silver or Enhanced Silver Plan to Bronze plan, here are some differences you might want to consider:

  • Bronze Plans offer the lowest monthly premiums, but have the highest out-of-pocket costs when you use services.
  • Silver Plans have higher monthly premiums than Bronze Plans, but have lower out-of-pocket costs than Bronze Plans.
  • Enhanced Silver Plans are available based on your annual income level and provide additional out-of-pocket savings.
  • Enhanced Silver Plans offer out-of-pocket savings through lower co-pays, or co-insurance and/or deductibles.
  • Enhanced Silver Plan enrollees, in general, get the benefits of a Gold or Platinum Plan for the price of a Silver Plan.

If you have questions about switching plans and your benefits, call 1-855-222-4239  (TTY 711) for free and confidential assistance.

How fast is the enrollment process?

Every situation is unique. Time may vary depending on whether you enroll as an individual or as a family. Expect to spend an average of about 40 minutes (sometimes less, sometimes more) to completely fill out your application.

After you have enrolled with L.A. Care Covered, you must make your initial binder payment for your coverage to start on January 1 of the enrollment year.

Once your payment is received, Covered California will send you welcome information, including a welcome letter and a brochure on how to use your plan.

L.A. Care Covered will then mail your ID card and a New Member Kit to guide you through your plan. Please note that once Covered California processes your payment, L.A. Care Covered has 10 business days to send your ID card and New Member Kit. Please call our member services department at 1-855-270-2327 (TTY 711) if you do not receive these items. 

L.A. Care Covered has representatives ready to answer your questions and help you receive free and confidential assistance. Simply call 1-855-222-4239 (TTY 711) to enroll by phone or to schedule an appointment, or visit us at lacarecovered.org to enroll online.

To expedite the process, please have handy Social Security numbers, birthdates, legal status documents and current income information for the family members in your household and you.

When will my new coverage start?

If you complete the enrollment process between October 15, 2018 and December 15, 2018, your coverage will be effective January 1, 2019.

If you complete the enrollment process on or after December 16, 2018, and on or before January 15, 2019, your coverage will be effective February 1, 2019.

Why do some metal level plans have lower premiums than what I'm paying right now?

I am a current L.A. Care Covered™ member. Why do some of the other metal level plans have much lower premiums than what I am paying right now? (Source: Covered California)

As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers, compared with what you are expected to pay in co-pays and deductibles.

Plans in the higher metal tiers have higher monthly premiums, but you pay less when you need medical care. If you choose to pay a lower monthly premium, then you will pay more when you need medical care. You can choose the level of coverage that best meets your health needs and budget.

Here is a breakdown of the different metal plans:

  • Bronze: On average, L.A. Care Covered pays 60 percent of your medical expenses, and you pay 40 percent.
  • Silver: On average, L.A. Care Covered pays 70 percent of your medical expenses, and you pay 30 percent.
    • In some cases, individuals may qualify for an Enhanced Silver plan. This means that when they choose a Silver plan, they have – based on their income – enhanced out-of-pocket savings through lower copays, coinsurance and deductibles. Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan. In the three categories of Enhanced Silver, L.A. Care Covered pays either 94 percent, 87 percent or 73 percent of expenses, with you responsible for the rest.
  • Gold: On average, L.A. Care Covered pays 80 percent of your medical expenses, and you pay 20 percent.
  • Platinum: On average, L.A. Care Covered pays 90 percent of your medical expenses, and you pay 10 percent.
  • Minimum Coverage Plan: In addition to the metal tiers, L.A. Care Covered offers a Minimum Coverage Plan for those who qualify. If you are under 30, you may be able to buy an additional health plan option called Minimum Coverage Plan. These plans usually have lower premiums and mostly protect you from worst-case scenarios. Those who have minimum coverage plans do not qualify to receive premium assistance (also known as Advanced Premium Tax Credits). Minimum coverage plans through L.A. Care Covered cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until you spend $7,150, after which all in-network services are covered at 100 percent.

 If you have questions about the metal plans and the price variations, please call 1-855-222-4239  (TTY 711) for free and confidential assistance.

How can I see which providers are in your network?

To see a list of providers in your community, use our Find a doctor or pharmacy tool. You can also call 1-855-222-4239  (TTY 711) and a representative can assist you with finding a provider close to where you live or work prior to enrolling.  If you are already a member of L.A. Care Covered, please call our Member Services department at 1-855-270-2327.

What if I enroll and my doctor is not on the plan?

L.A. Care representatives can help you find a doctor close to where you live or work. You can also call 1-855-222-4239 (TTY 711) and a representative can assist you with finding a provider close to where you live or work prior to enrolling.  If you are already a member of L.A. Care Covered, please call our member services department at  1-855-270-2327 (TTY 711).

Will L.A. Care Covered continue participating in the Covered California market place?

Yes. L.A. Care’s mission is to provide access to quality health care for Los Angeles County's communities and residents and to support the safety net required to achieve that purpose. As a health plan committed to serving vulnerable communities, L.A. Care is determined to persevere despite uncertainty in Washington, D.C. even if it means we are the last plan standing.

Why is L.A. Care not participating in the Silver 70 Off Exchange plan?

L.A. Care does not feel that a plan at this price level is aligned with our unique mission to serve the low income and vulnerable population of Los Angeles County. An “Off Exchange” plan is health care coverage that you can purchase outside the Covered California Exchange that has similar benefits to coverage on the Covered California Exchange but which does not include premium cost subsidies. We will continue to offer the same metal level plans we make available on Covered California to anyone who would like to enroll in them directly with L.A. Care.